Download Appendix 4 HCCG topical medication guidance sheet April 16

Appendix 4
ADMINISTRATION OF TOPICAL MEDICATION
Procedure for service users unable to apply their own prescribed topical medication:
 A Registered Nurse or Senior Care Assistant should complete a Topical Medicines Application
Record (Topical MAR) for each topical medication prescribed. Ideally this should include a body
map.
 The Topical MAR should be kept in the resident’s room if in a care home.
 The Care Assistant or Registered Nurse should sign the Topical MAR when they have applied a
topical medicines in line with the prescription instructions.
 The Medical Administration Record (MAR) chart should state “see Topical MAR chart” where applicable
 At the end of each 28 day cycle the Topical MAR should be attached to the corresponding MAR
chart to provide a full record of administration and ensure appropriate re-ordering of stock.
 Gloves should always be used when applying topical medication
Key Points:
 Check expiry date before use
 Highlight any short expiry dates as a reminder to all personnel involved in patient care
 Record the date opened and the calculated expiry on the medicine package/label. Some packaging
does not allow for the pharmacy label to be placed on the product e.g. eye drops. In these
circumstances the outer packaging will have to be endorsed with the date of opening. It is essential
that the product remains in the outer packaging throughout duration of this treatment.
 Any product whose appearance suggests it may be unfit for use should be discarded.
 Use a Topical Medicines Application Record for recording administration of topical
preparations and expiry date information for topical medications. A suggested topical medicines
application record sheet is enclosed.
Table of Suggested Expiry of Topical preparations from Date of Opening
NB Due to the lack of available evidence on generic expiry dates of creams/ointments the following expiry dates are suggested
Formulation and packing
Suggested expiry after
opening unless otherwise
stated by manufacturer and
still within manufacturer’s
expiry date
Rationale
Tubs of creams/ointments
3 months
The contents are exposed and
can become contaminated
Tubs of creams/ointment
decanted from bulk container
1 month or seek community
pharmacy or dispensary advice
As above, and decanting from
bulk container into another container
could introduce contamination
Tubs of cream specially made
for individual
Seek community pharmacy or
dispensary advice
Dependent on stability of product
Tubes of creams/ointments
6 months
Closed container, contents less
exposed to environment
Pump dispenser packs of
creams/ointment
Manufacturer’s expiry
Closed container, contents not
openly exposed to environment
Some products now show an expiry symbol. However, in the care home setting where storage conditions
may be variable it is recommended that the above suggested expiry dates are followed.
Any products whose appearance suggests it may be unfit for use should be discarded – irrespective of expiry
date. If there is any doubt contact the community pharmacy/dispensary for advice.
As a guide the following table shows the difference in suitable quantities of topical creams/ointments as
opposed to topical corticosteroids for an adult:
AREA OF BODY
CREAMS/OINTMENTS
Twice daily application
CORTICOSTEROIDS
Single daily application
Per Week
Per Month
Per Week
Per Month
Face
15-30g
60-120g
8-15g
30-60g
Both hands
25-50g
100-200g
8-15g
30-60g
Scalp
50-100g
200-400g
8-15g
30-60g
15-30g
60-120g
100-200g
400-800g
50g
200g
400g
1600g
50g
200g
15-25g
60-100g
8-15g
30-60g
Both arms
Both legs
Trunk
Groins and genitalia
Special advice for administering topical corticosteroids:
These should be applied no more frequently than twice daily and should be spread thinly. The length of
cream or ointment expelled from a tube can be measured in “fingertip units” (the distance from the
fingertip to the first crease of the finger in an adult index finger), One “fingertip unit” (approximately 500mg
of cream or ointment) is enough to cover an area that is twice that of the flat adult handprint (palm and
fingers). ¹
¹BNF 66 – September 2013
Resources:
Continuing Professional Pharmacy Education (CPPE) Supporting Care Homes in Medicines Management April 2007
Expiry dates Sheffield care homes steering group 2010
Version 1.1 2016 _Review Date: March 2017
Topical Medicines Application Record Sheet
Name of Patient:
D.O.B:
Room No: GP:
Name of Topical Preparation:
Allergies:
Completed by:
Checked by:
Site of application (mark on body map):
How to be applied e.g. thinly, liberally, use as a soap:
Frequency of application e.g. daily, after washing:
Month:
Date
Start date:
Time
Storage e.g. fridge
Signature
End date:
Time
Signature
Date opened:
Start day:
Time
Signature
Expiry date after opening:
Version 1.1 April 2016